What to do if you have anal fissure during vaginal delivery

There are many uncontrollable factors during normal childbirth, which requires pregnant women to make the greatest preparation and make the greatest effort. If improper force is used during a normal birth, problems such as heavy bleeding, retinal detachment, and even anal fissures can easily occur. Anal fissures are very common during normal childbirth, so pregnant women are required to understand the correct posture and force method for delivery in advance and be prepared for delivery. Let us understand together, if anal fissure unfortunately occurs, what should we do?

Anal fissure is a very common disease among women after childbirth. The main reason why postpartum women are prone to anal fissure is that the vagina expands and tears during childbirth, involving the anus.

It is the anal canal, and fissure is a crack. Anal fissure is the crack on the surface of the narrowest anal canal tissue from the dentate line to the anal margin at the outlet of the digestive tract, forming a small ulcer parallel to the longitudinal axis of the anal canal, fusiform or oval, about 0.5 to 1.0 cm long, and often causes severe pain around the anus. The most common location of anal fissure is the anterior-posterior center of the anus, with the anterior center being the most common. The incidence of anal fissure accounts for about 20% of anorectal diseases, mostly affecting young people, but anal fissure is more common in women, especially young women. The incidence rate in women in my country is about 1.8 times that of men, while the result reported in the Journal of the Japanese Society of Colon and Anorectal Surgery is 1.6 times. Anal fissures can be divided into acute and chronic. Chronic anal fissures, due to their long course and repeated attacks, cause edema of the anal flap and anal papilla at the upper end of the fissure, resulting in hypertrophy of the anal papilla, and the skin at the lower end drooping in a bag-like shape and protruding outside the anus, forming "sentinel piles". Anal fissures, sentinel piles, and hypertrophy of anal papillae often exist at the same time, which is called the anal fissure triad.

treat

Most patients with chronic anal fissures have their primary constipation or diarrhea corrected, or have a trial of topical medication. For patients who do not respond well to conservative treatment, anal fissure resection and/or internal sphincter lateral incision may be considered. Acute or new anal fissures can be healed by increasing fiber and water intake and taking warm sitz baths.

1. Correct abnormal bowel movements

Constipation is one of the main symptoms of anal fissure and the main cause of anal fissure. It can be softened and kept smooth by increasing dietary fiber foods or taking vitamin supplements. For constipation, you can use laxatives and take probiotics.

2. Clean the anus and take a sitz bath

Take a sitz bath with 1:5000 potassium permanganate in warm water after defecation or before going to bed to keep the area clean.

3. Topical medication

(1) Analgesic anesthetics (such as lidocaine gel) and non-steroidal anti-inflammatory drugs (such as diclofenac cream, ibuprofen cream, etc.) can relieve pain symptoms.

(2) Hemorrhoid creams that promote wound healing, recombinant human epidermal growth factor, etc.

(3) Topical application of nitroglycerin ointment: Apply 0.2% nitroglycerin ointment to the anal fissure twice a day for 5 to 8 weeks. This drug has the effect of inhibiting neurotransmitters and relaxing smooth muscles and dilating blood vessels. It can relax the internal sphincter, reduce anal canal pressure, and improve local blood circulation.

(3) Local injection of small doses of botulinum toxin can weaken the tension of the internal sphincter. 0.1 ml of diluted botulinum toxin is injected through the external sphincter next to the anal fissure, causing chemical denervation and local muscle paralysis, thereby reducing muscle tension.

4. Anal dilation

Suitable for patients with acute or chronic anal fissures without complications of papillary hypertrophy and sentinel piles. Dilatating the anus with fingers or instruments (the trumpet-mouthed anoscope commonly used in anorectal surgery can be used) is effective in relieving severe anal pain, but it can recur and may be complicated by adverse reactions such as anal hematoma, bleeding, and anal incontinence for a short period of time.

5. Surgery

It is suitable for patients with anal fissure triad or chronic anal fissure that is resistant to non-surgical treatment. Commonly used surgical procedures include anal fissure resection and lateral internal sphincterotomy.